As millions of people around the world became confined to their homes due to the COVID-19 pandemic, concern grew about the implications for children. It was unclear how school-age kids would respond to restrictions on their activities and to attending school remotely. This was even more worrisome for children with attention deficit hyperactivity disorder (ADHD). Several weeks after COVID-19’s recognition as a pandemic, the FDA approved Akili Interactive’s Endeavor RX video game under its COVID-19 enforcement discretion guidance. it was considered a low risk digital health device and it already had clinically validated data.
ADHD
ADHD is a mental health condition characterized by trouble focusing (inattentiveness) and hyperactivity.(6) In children, this disorder typically affects their ability to succeed in school. Historically, treatment for ADHD combines behavioral therapy and medication. More recently, doctors and researchers have utilized digital health technologies to address limitations such as medication abuse, and accessibility to properly trained pediatric mental health specialists. (1) The most important questions when evaluating the efficacy of digital health tools concern its efficacy, cost, ease of use and barriers to access for the target population.
Endeavor RX by Akili Interactive
While Endeavor RX is the first FDA approved game-based therapeutic, it is not the first digital health tool to address ADHD. Companies have built websites, games, apps, robots and digital devices, virtual reality experiences, and mobile text messages. These various tools complement traditional ADHD treatment options to offer diverse interventions that can be offered anywhere, empowering children to take ownership of their condition. The decision about what type of digital health tool to use is personal, depending on the child’s specific needs and interests. For that reason, sometimes it is difficult for a child to incorporate useful tools into their routine because of a lack of interest.
Endeavor RX is exciting because it is therapeutic while attention-grabbing to many children. Data from two small pilot studies and three larger clinical trials evaluating over 600 children with ADHD showed that the use of Endeavor RX significantly increased attentional functioning (1). The data suggests that the video game increases activity in the prefrontal cortex, evaluated by a functional electroencephalogram (EEG), to help children with ADHD improve attention, inhibition, and working memory (1).
So, is Endeavor RX effective? The answer goes back to the important questions posed earlier.
Is the treatment effective?
According to the published data, the video game seems to significantly increase functioning for ADHD patients. Further studies will need to be evaluated to determine the optimal duration and consistency of play for long-term benefits.
What are the barriers and facilitators to engaging the target population in the therapy?
It depends on the individual child. For children who love playing video games, then this game could be an easy addition to their routine and they would be likely to keep up with the treatment. However, for children who have no interest in video games, perhaps another treatment option would be more useful.
While Endeavor RX may not be for everyone, it opens an exciting door into the future of digital health technologies that make therapy more ubiquitous and enjoyable. This is especially important for children who are less likely to comply with treatments unless their parents are strictly involved. Time will tell what other types of innovations come out of this field, but for now playing video games as a therapy seems like a pretty fun option.
